Report Type: Assessment Plan Recommendations
Behavioral Health Needs & Gaps in NM
YEAR
2002
AUTHOR / ORGANIZATION
Technical Assistance Collaborative, Inc. & Human Services Research Institute
GEOGRAPHIC SCOPE
Bernalillo County, Statewide (New Mexico)
What is this?
This is a comprehensive statewide behavioral health needs and gaps assessment conducted in response to legislative directives (Senate Bill 628 and Senate Joint Memorial 14) and Medicaid waiver continuation requirements. The study was funded by four state agencies and three managed care organizations, and conducted by the Technical Assistance Collaborative and Human Services Research Institute. The methodology employed multiple approaches including data analysis from BHSD, MAD, and CYFD; document and literature reviews; key informant interviews; focus groups across the state; consensus panels of clinicians; surveys of provider agencies and individual practitioners; and computer-supported modeling for cost projections. Over 1,700 people participated in providing input. A project team of 18 professionals conducted the assessment, including consumer specialists, economists, statisticians, and cultural consultants.
Summary
This comprehensive assessment identifies significant gaps between behavioral health needs and services delivered in New Mexico, with particular attention to Bernalillo County (Region 5). The report finds that 63% of behavioral health dollars are spent on inpatient and residential services for only 11% of people served, indicating a misalignment with evidence-based community care models. Key recommendations for systems change include establishing a Cabinet Cluster to coordinate behavioral health across all departments, developing common service definitions and data systems, redesigning Medicaid benefits to maximize federal resources, and investing in community-based alternatives to institutional care including crisis services, in-home wrap-around services, and integrated care for persons with co-occurring disorders. The report emphasizes that Bernalillo County has the highest concentration of licensed practitioners but also serves proportionally fewer of those in need (11%) compared to other regions. Priority service development areas include crisis services and jail alternatives, therapeutic foster care, transition services for youth aging out of systems and adults leaving incarceration, and culturally-specific services for American Indians and Hispanic/Mexican populations. The report provides a roadmap for shifting from fragmented, institution-heavy service delivery toward an integrated, community-based continuum of care.
BH Systems Change Recommendations
The report contains extensive explicit behavioral health systems change recommendations organized into five categories: **System Recommendations** 1. Create Cabinet Cluster for Behavioral Health authorized to plan across all departments 2. Develop and use common service definitions, protocols, standards, goals and expected outcomes 3. Establish common reporting requirements and data system development 4. Conduct regional planning involving all systems' managers and stakeholders 5. Redesign Medicaid benefits to maximize federal resources and change service delivery patterns 6. Establish statewide and regional human resource development data and planning 7. Change licensing practices to gather consistent information and remove barriers **Service Priority Recommendations** 8. Crisis services and jail/hospital alternatives 9. In-home and wrap-around services for children and families including therapeutic foster care 10. Integrated services for persons with co-occurring needs (MI/MRDD or MI/SA) 11. Mental health and substance abuse services for youth in state custody 12. Transition services for adults leaving prisons and jails 13. Transition services for adolescents moving to adulthood 14. Consumer and family-operated services 15. Substance abuse services for adolescents 16. Intensive outpatient services for substance abusing adults 17. Assertive community treatment/intensive case management for adults with SMI 18. Culturally specific services for American Indians, Mexican immigrants, and Hispanic populations 19. School-based behavioral health clinics and services 20. Supported employment and housing for adults **Infrastructure Priority Recommendations** 21. Development of Behavioral Health Cabinet Cluster and related activities 22. MIS enhancements to collect and report common data elements 23. Creation of New Mexico Behavioral Health Institute for human resource development 24. Individual practitioner and provider agency data collection and registry 25. Common credentialing process and utilization management criteria
How to Use for Systems Planning
**What this report IS useful for:** - Understanding historical baseline of behavioral health needs and system capacity in New Mexico - Identifying persistent structural barriers that may still exist in behavioral health systems - Providing prevalence data methodology that can be updated with current figures - Offering framework for regional analysis, particularly for Bernalillo County (Region 5) - Documenting evidence-based service priorities that remain relevant (crisis services, community-based care, integrated treatment) - Understanding the cost-benefit case for behavioral health investment - Identifying special population needs including co-occurring disorders, justice-involved, homeless, and transition-age youth **What this report DOES NOT provide:** - Current service utilization or capacity data (report uses FY 2001 data) - Analysis of changes since 2002 including Medicaid expansion, any behavioral health collaborative developments, or recent legislation - Current practitioner workforce data - Updated cost projections adjusted for inflation or system changes - Analysis of COVID-19 impacts on behavioral health needs or services - Information on current evidence-based practices that have emerged since 2002
Key Facts & Data Points
- Over 500,000 individuals in New Mexico have substance abuse/dependence or mental disorders (approximately 28% of state population) - 150,137 persons estimated to be affected by substance abuse or dependence - 368,721 individuals have some kind of mental disorder - 70,766 adults have serious mental illness (SMI) - 18,594 children/adolescents ages 9-17 have severe emotional disturbance (SED) - Only 19% of adults needing public sector mental health services are being served - Only 14% of those needing behavioral health services statewide are being served - 51,608 unduplicated individuals received behavioral health services in FY 2001 from major funders - 63% of all behavioral health dollars spent on inpatient and residential services for only 11% of people served - 27% of New Mexico's non-elderly are uninsured compared to 16% nationally - 24% of New Mexico children are uninsured compared to 12% nationally - Current spending: $32 million substance abuse, $90 million mental health - Good system would require: $169 million substance abuse, $197 million mental health - Ideal system would require: $217 million substance abuse, $327 million mental health - 423 behavioral health provider agencies identified statewide - Only 58% of licensed psychiatrists have New Mexico addresses - Almost 80% of in-state psychiatrists practice in Bernalillo and Santa Fe Counties - For every dollar spent on substance abuse treatment, $7.14 saved in other costs - For every dollar spent on mental health services, up to $10 saved in other costs
Priority Services & Findings
**SUD Organizations** - Only 14% of substance abuse services funding goes to treatment; 40% to DWI program - 14,660 youth ages 12-17 and 82,235 adults are dependent on alcohol or drugs - 4,365 adolescents ages 15-17 and 45,830 adults estimated to be substance abusers - 3,047 individuals in jails/prisons have substance use disorders - Intensive outpatient services critically underdeveloped - Need for adolescent substance abuse services identified as priority - Integrated services needed for co-occurring mental illness and substance abuse **Mental Health / Crisis Care** - Crisis services and jail/hospital alternatives identified as top priority - Mobile crisis and respite services need development before adding residential capacity - Assertive community treatment and intensive case management needed for adults with SMI - Consumer and family-operated services need expansion - Peer Bridger program and Consumer Leadership Academy identified as exemplary - Jail diversion program in Dona Ana County helping mentally ill engage in treatment **Integrated Primary Care** - 63% of behavioral health spending on inpatient/residential serves only 11% of recipients - Community-based, in-home services significantly underdeveloped - Co-occurring disorder services should be integrated rather than sequential - BHSD implementing statewide comprehensive, continuous, integrated systems of care model - Need for integrated services for MI/MRDD population **School-Based / Youth Services** - School-based behavioral health clinics and services identified as priority - 35% of those served are children ages 0-17 (compared to 28% of population) - Wrap-around and in-home services for children and families needed - Therapeutic foster care capacity needed - Transition services for adolescents moving to adulthood critical gap - Multi-system therapy being developed in Santa Fe and Albuquerque - Sexual Assault Nurse Examiner (SANE) program in Santa Fe identified as exemplary
Immediate Actions for Systems Planners
-Compare 2002 baseline findings with current data to identify which gaps persist and which have been addressed over the past 20+ years in Bernalillo County -Assess whether the recommended Cabinet Cluster or equivalent cross-system coordination mechanism exists and is functioning effectively -Evaluate current crisis service capacity and jail diversion programs against the report's recommendations -Review current Medicaid benefit design to determine if recommendations for maximizing federal resources have been implemented -Assess current workforce distribution data to determine if practitioner concentration in Bernalillo/Santa Fe Counties has improved -Evaluate whether common service definitions and data systems have been developed across behavioral health agencies -Review current spending allocation to determine if the 63% institutional/37% community ratio has shifted toward community-based care -Assess availability of integrated services for co-occurring disorders and MI/MRDD populations -Evaluate transition services for youth aging out of systems and adults leaving incarceration -Determine whether school-based behavioral health services have been expanded as recommended
Key Contacts
**/ - Behavioral Health Services Division (BHSD), Dept of Health = -Children Youth & Families Dept (CYFD) Prevention & Intervention Division = - Developmental Disabilities Planning Council (DDPC) **/ - Human Services Research Institute = - Managed Care Organizations: Cimarron, Lovelace, Presbyterian = - Medical Assistance Division (MAD), Human Services Dept = **/ - Technical Assistance Collaborative, Inc. = - UNM Center on Alcoholism, Substance Abuse & Addictions (CASAA) = - UNM Rural Psychiatry Program